Provider Demographics
NPI:1992243638
Name:PLATTE VALLEY AMBULANCE SERVICE LLC
Entity type:Organization
Organization Name:PLATTE VALLEY AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-498-1601
Mailing Address - Street 1:1750 E EGBERT ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2326
Mailing Address - Country:US
Mailing Address - Phone:720-385-8420
Mailing Address - Fax:303-654-8166
Practice Address - Street 1:1750 E EGBERT ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2326
Practice Address - Country:US
Practice Address - Phone:720-385-8420
Practice Address - Fax:303-654-8166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTON HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-02
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO569257Medicare PIN